Since he was diagnosed with type 2 diabetes 25 years ago, Jeffrey Hermann gradually gained more weight and, at age 60, met the medical definition of “morbidly obese.” As the years progressed, the diabetes and extra pounds had increasingly affected his health and challenged his performance on the job. Mr. Hermann took insulin and oral diabetes medications, while continuing to struggle to keep the disease under control. “My A1C (a person’s average blood glucose levels over the previous three months) and fasting levels were too high,” says Mr. Hermann, a resident of London, Ontario. “I was starting to feel some health concerns, and I knew these emerging complications could create serious difficulties if left untreated.”He was also feeling sleepy and weak almost all the time, including at work. “I’m grateful that I have very understanding and patient employers at the company where I work as an accountant,” he says. But Mr. Hermann himself was losing patience. “Wanting to lose weight was one thing, but I was particularly motivated to get the diabetes under control,” says Mr. Hermann. He began to explore options for surgical treatment and, after extensive research, decided to have a mini gastric bypass procedure at the SmartShape Weight Loss Centre in Mississauga, Ontario. According to Diabetes Canada clinical practice guidelines, an estimated 80 to 90 per cent of individuals with type 2 diabetes are overweight or obese. And losing weight helps people better manage their blood glucose. “A modest weight loss of 5 to 10 per cent of initial body weight can substantially improve glycemic control and cardiovascular disease risk factors,” say the guidelines. SmartShape’s medical director and CEO, Chris Cobourn, performed the procedure for Mr. Hermann in March 2017. He explains that procedures such as the mini gastric bypass have been shown to help patients maintain sustained weight loss and thus improve weight-related health conditions such as diabetes at significantly higher rates than with counselling-supported diet programs. The Diabetes Canada guidelines also say, “Bariatric surgery may be considered for appropriate patients when other interventions fail to achieve and maintain a healthy body weight.”The mini gastric bypass has also been shown to have many health benefits beyond weight loss itself, Dr. Cobourn says.

“We have come to realize that bariatric surgery addresses a wide range of metabolic problems, including type 2 diabetes, sleep apnea, high blood pressure and high cholesterol,” explains Dr. Cobourn. “In fact, we are reframing this type of surgery and now call it metabolic surgery. “With the mini gastric bypass, we bypass the first part of the small bowel, the duodenum, and when food no longer goes through it, the body responds quickly by changing a number of hormone levels that result in enhancing the metabolic response and a mimic effect of insulin.”Before having the procedure in March of 2017, Mr. Hermann weighed 320 pounds and had a body mass index (BMI, a calculation of height vs. weight) of 49. After only a few months, he has lost 108 pounds, has a BMI of 32, is no longer taking insulin or blood pressure pills, and has cut his diabetes medication dosage in half. His energy has increased dramatically. “Soon after the surgery, my sugar controls were very good, to the extent that I would have told people that my diabetes was gone. I was very pleased, but then my sugar levels started to creep up a bit,” Mr. Hermann says. “It’s a learning curve. My A1C is much better than it was, but still higher than it should be.”Mr. Hermann is working with SmartShape’s nurse specialists and dietitians to help him learn to manage his diabetes, with the goal of leaving his medications permanently behind. The centre provides five years of follow-up support with its multidisciplinary team of experienced health-care professionals to guide patients on key nutrition and activity lifestyle changes. “This is very important. It is what differentiates a successful program, the support that patients get afterwards,” says Dr. Cobourn. “We provide tools to help patients work with their procedure of choice to get the results that are possible and that they would expect.”